A Birth Doula for Every Motherby Allie Chee
With excerpts from New Mother

[Editor’s note: This article first appeared in Midwifery Today, Issue 104, Winter 2012. The author’s follow-up article may be viewed here: A Postpartum Doula for Every Mother]

A majority of women—and our society as a whole—have relinquished pregnancy, childbirth and their postpartum time to the dictates of profit-driven institutions. However, many women are rediscovering that there is more to pregnancy than what we usually hear in literature and in doctors’ offices. More and more women are ready to reclaim the magic in motherhood!

A woman wanting a more natural, nurturing and sacred experience into motherhood has many resources available to support her in her goals: doulas, midwives, postpartum doulas, Traditional Chinese Medicine (TCM) practitioners, chiropractors, mother’s concierge services and more. We will discuss only one of these resources here—one that can be of enormous help during a homebirth or hospital birth: the birth doula.

The Template Birth

If you are not planning your birth—meaning you are using the hospital template that’s been prepared for you by institutions, corporations and commercially-funded committees—the odds are extremely high that:

When you enter the hospital, you will either be placed in a wheelchair or you will walk to a labor room. You will be hooked up to an IV, one or several monitors and denied food and even beverages (other than ice chips, which in many cultures are considered something to avoid in labor).

Depending on how “progressive” the hospital and staff are, you will be allowed or encouraged to walk around and work in different labor positions to encourage the baby into an optimal position and allow labor to progress, or you will simply be advised to stay flat on your back—which is considered by many in the birthing world to be one of the most painful and least effective ways to labor.

Around the time you start experiencing stronger contractions and the pain sensations are increasing, hospital staff (strangers) will appear at your door encouraging the use of drugs.

You will be checked periodically by doctors, residents, nurses and student nurses (more strangers). When you’re dilated far enough, they will move you to the delivery room where your doctor, or a stand-in if he or she has been called away to more pressing matters, will stay with you as the baby and the placenta are born.

This is all assuming that you’re not put on additional drugs to speed labor (if in their estimation you’re taking too long). While 24 hours or longer is a common length of time for a mother to labor—especially with her first baby—many hospitals encourage drugs to speed the process if it passes 12 hours.

The job of a birth doula is…

…to give love and support to a family while they embark on their journey into parenthood.
— Colleen Curry, doula

…to make birth easier and more peaceful through emotional support and physical comfort—regardless of where a mother gives birth.
— Lauren Kunis, NYC Doula Service

…to ensure that the client can look back on her birth, and know with certainty that she is an absolute goddess.
— Mandi Woolery, Peachy Keen Birth Services

…to support the mother in her birth goals, whatever they might be.
— Chris Goldman, Doulas of CNY

The postpartum doula helps to provide continuity of care to new parents after the birth of their baby by educating, nurturing and encouraging mothers and families towards confidence in their new roles.
— Darla Burns, Executive Director of Postpartum Doula Programs for CAPPA

It is also assuming that nothing has happened to encourage the doctor to perform a cesarean (now at 30–50% of births in the US, varying by doctor and hospital).

All in all, as Jennifer Block states in her book Pushed: The Painful Truth about Modern Childbirth and Maternity Care, a mother, even in a “routine” birth in a hospital, may have “up to 16 different tubes, drugs or attachments” (Block 2007, xiv).

After the baby and placenta are born, in most instances they are both taken away: the baby to be washed (unnecessary and considered by many to be stressful for the newborn who’d rather be on her mother’s chest), weighed, measured and treated with various pharmaceutical products and the placenta to an incinerator.

Whoa! How has the most sacred rite of passage become so cold and offensive? Where’s the romance, the beauty, the nurturing? Where’s the love?

We can all see the need for a different approach and the need for support—for someone who understands the needs of the mother, supports and advocates for her. A person with whom she’s met, established rapport and trust, and who she knows will be there when the big moment arrives. Someone who’s not a friend, mother-in-law, nor the father—they have different roles.

The birthing mother needs a person who has witnessed and participated in at least dozens, if not hundreds, of births to represent her best interests and desires when push comes to shove!

The Birth Doula, at the Hospital

If you’re going to have a hospital birth, having a doula with you can be enormously beneficial.

A doula, generally speaking, is a birth support person, meaning someone experienced in what you want to achieve, who assists you physically and emotionally to achieve it.

I asked birth doulas across the country to describe their multifaceted roles in just one sentence. There is a generally accepted definition of the role, with room for fine nuances to match every doula’s and mother’s ability, experience and desire. Ultimately, the role of the doula is whatever the mother and doula decide together the role should be.

Today the job of a professional doula usually includes:

Understanding deeply the physical and emotional needs of a woman in labor.

Many fathers are not the ideal doula. He may offer great support, help and love during the labor process, but it is the father’s labor process, too. Because he is deeply involved emotionally and because he doesn’t have experience supporting a mother in labor (and one or two previous births don’t come close to making either parent truly experienced), it may be helpful for him to have the option to simply support the mother (and himself) with loving physical contact and encouragement—not as the primary labor support or as the sole intermediary with hospital staff. For similar reasons, friends and other family members may not be the ideal doulas.

A doula works for the mother. She’s hired and paid to support and to be an intermediary to (not to replace) the medical staff, and she is hired to support the mother’s wishes. Ideally having extensive experience, a doula can understand and even anticipate the physical and emotional feelings and needs a mother goes through in labor and has a tool kit of ways to best respond to those needs.

Helping the mother understand the process and to design a birth plan.

If a mother is planning a hospital birth and intends to give birth naturally with the least amount of interventions possible, she will need to know what procedures are going to be encouraged (if not forced on her) and which ones she will be able to decline or modify. An experienced doula will be aware of the procedures and practices of local hospitals and will be able to help the mother plan.

Many mothers want a natural childbirth, but they have no idea what protocols they will be up against when entering the hospital—one reason for so many altered birth plans and so many women who aren’t able to realize their dream of a natural experience. A doula cannot guarantee the mother’s plan will be followed or possible, but she can educate the mother so she knows what to expect behind the hospital doors.

A birth plan is a written document that should be read and respected by your doctor and hospital staff, but according to some doulas I’ve spoken with, this isn’t always the case (if the plan is too long, poorly written, etc.). Your doula can help you write a brief and concise plan that is more likely to be read, respected and followed.

Helping the mother achieve her birth plan by supporting her and acting as an intermediary between her and her family or, in the case of a hospital birth, between her and the staff.

For a homebirth, the doula almost always works in complete harmony with the midwife, and both work to best achieve the woman’s birth plan. In the Ob/Gyn and hospital world, birth plans are often discouraged, frowned upon or simply ignored. There are always exceptions, but mothers must often dedicate a great amount of time interviewing to find doctors who support truly natural birth experiences in the hospital environment.

In the case of monitors, IVs, food, beverage, music and labor positions—rules vary from hospital to hospital about what is forced, what is allowed and what can be declined. Your doula should know your hospital’s policies and the two of you should prepare for them ahead of time.

If there is a nurse or any staff member whom you’d rather not see in your room again for whatever reason, your doula will see to that. If you need another blanket or pillow, your doula will find one (you don’t need to find a nurse and be told you’ve already reached your pillow quota). When you think you’re surely dying and perhaps do need drugs, your doula is there to comfort and encourage you, to tell you that you’re doing great and that even if you claim you’re close to death with each contraction, it’s normal, perfect and all is going according to what you dreamed!

Note: It’s a good idea to discuss with your doula ahead of time how she should respond if you change your plan when the pain peaks. I told my midwife, “I can take it. If I’m acting like I want to veer from my plan, that will only be fear talking. You can soothe or yell at me, or both—whatever it takes to keep me on course.” (She laughed and said she wouldn’t be yelling at me.) Other mothers may tell a doula, “If I change my mind and want drugs, help me get them ASAP,” and that’s what the doula will strive to do.

Many hospital staff members will make it seem as if there are no alternatives to things such as laboring on your back, fetal monitors, IVs, forceps, wearing the hospital gown and ice-chip-only rules. That is why having someone at your birth who understands hospital procedures and possible alternatives is beneficial.

And whether you’re like me and think that home is the safest, happiest place to have your baby or you believe you’ll feel better cared for and safer in a hospital, either way, you’ll be well served with a birth doula by your side.

The Birth Doula at Home

While your midwife is experienced in helping women birth their babies, you’ll likely spend more time with your doula on the day of birth. Often a midwife is able to provide emotional support, but her primary role is helping you give birth to your baby. The doula’s primary focus is on supporting the mother, emotionally and physically.

Here’s a specific example from my homebirth to illustrate this last point. During the early stage of labor while resting in the birthing tub, my body suddenly started to jackknife with pushing (I was not consciously doing it). My midwife told me to stop—that I was only 5 cm dilated, and it wasn’t time to push. I told her that I couldn’t stop—that my body seemed to be on autopilot.

She asked me to step out of the tub so she could assess the situation. Naturally, I was alarmed that something was wrong and began to feel nervous. However, as my midwife checked, identified the issue and found the solution, my doula held my hand, held eye contact with me and told me I was doing great.

The midwife—whose role is also multifaceted—will be frequently focused on and examining the mother’s body and the baby. The doula will remain focused on the mother’s eyes and mind (helping her with loving assurances and calming her with physical contact such as holding her hand, brushing her hair out of her eyes or putting an arm around her shoulder), while the midwife does her work. That’s a vital contribution—a calm mind supports a relaxed, open heart and cervix!

Earlier I asked the question of modern birthing templates: Where’s the love? Now we know where to start looking—with the help of a birth doula.

How to Find a Doula

Short of having a friend who lives in your area and highly recommends a doula she knows, you’ll need to find one through a variety of channels. What I found most efficient was to conduct a search online, look at the various agencies that refer or certify doulas and simply look for websites of doulas working in the area. After speaking with a few you’ll have a better idea of what kind of support you will want, what is available and with whom you feel rapport.

Some will have years of experience and some will be new to the industry—how much importance you place on this is a personal decision. I know many mothers who insist on working with highly experienced people, and I know many mothers for whom feeling “the click” is the top priority.

What Does It Cost?

With regard to cost, once again, there is a doula for every mother. Some doulas charge $400–500, allow a payment schedule rather than the entire fee at once or may even serve a mother in childbirth at no cost if the fee is prohibitive for the mother. A newer doula may also offer free or discounted services while she tries to build up her experience attending births. Other doulas may charge up to $2000 or more (the fee can largely be dependent on the part of the country in which you live).

The Postpartum Doula

A birth doula can be a tremendous support for mom on her special day. But then what?

The postpartum time—especially the first 30–40 days—presents different needs and challenges for the mother and family. At this special time of bonding and healing, a mother can be well served with the help of a postpartum doula.

I hope this discussion of birth doulas and the benefit they bring to new mothers will encourage readers to also explore the possibility of having a postpartum doula—someone who can serve the mother, baby and entire family as they go forward in their magical journey called parenthood. My next article, “A Postpartum Doula for Every Mother,” will appear in the Spring 2013 issue of Midwifery Today.

Allie Chee is the author of New Mother: Using a Doula, Midwife, Postpartum Doula, Maid, Cook or Nanny to Support Healing Bonding and Growth. She is also a certified TCM nutritionist and a homebirth mom. www.alliechee.com

Through networking and education, Midwifery Today's mission is to return midwifery care to its rightful position in the family, to make midwifery care the norm throughout the world, and to redefine midwifery as a vital partnership with women.